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Tangential views or computed tomography in suspected depressed skull fracture

Three Part Question

In [patients presenting with head injury and suspicion of depressed skull fracture] is [tangential x-ray or CT scan better] at [detecting depressed skull fracture]?

Clinical Scenario

A 35-year-old man alleges that he has been assaulted. He claims that he was hit on the head with a hammer. He is only complaining of pain around the site of the injury. On examination there is haematoma present, but no laceration. Standard skull views reveal no bony injury. You suspect a depressed skull fracture and wonder whether a tangential x-ray of the site of the injury, or a CT scan would be better able to detect it.

Search Strategy

Medline 1966-04/02 using the OVID interface.
[exp skull fractures OR exp skull fracture, depressed OR ({ OR OR} AND { AND})] AND [exp x-rays OR OR OR OR] AND [exp tomography, x-ray computed OR OR OR ct scan$.mp] LIMIT to human AND English.

Search Outcome

No papers were found that addressed the three-part question.


Intuitively it would seem that CT scan is the best method available to investigate such injuries. However, there is no evidence to show that it is better than tangential skull views.

Clinical Bottom Line

Local neurosurgical advice should be followed.